Provider Demographics
NPI:1023624301
Name:POSE, SARAIS (CMT)
Entity type:Individual
Prefix:
First Name:SARAIS
Middle Name:
Last Name:POSE
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 CAMINO REAL APT 508
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-4525
Mailing Address - Country:US
Mailing Address - Phone:813-919-9253
Mailing Address - Fax:
Practice Address - Street 1:1108 CAMINO REAL APT 508
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-4525
Practice Address - Country:US
Practice Address - Phone:813-919-9253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14420225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist